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General NPI Number Information
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NPI Number | 1043879240
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Entity Type | Organization
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Legal Business Name | INDIAN CREEK FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 5938 WEST SR 135
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City | TRAFALGAR
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State | IN
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Zip | 46181
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Country | US
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Telephone | 812-597-5857
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Fax |
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Provider Business Mailing Address
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Address Line | 5938 WEST SR 135
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City | TRAFALGAR
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State | IN
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Zip | 46181
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Country | US
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Telephone | 812-597-5857
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ALLISON STROPES
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Credential |
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Telephone | 812-597-5857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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